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Year 4 General Medicine > Stroke > Flashcards

Stroke Flashcards

1
Q

aims of stroke management

A
  1. is the disability reversible with treatment? ie timeframe
  2. rehabilitation - how to help patient back to living their life
  3. how to prevent next stroke?
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2
Q

thrombolysis

A

<4.5hr

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3
Q

thrombolysis timeframe

what is used?

A

<4.5hr

recombinant tPA / alteplase

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4
Q

ischaemic stroke management

A

thrombolysis

thrombectomy

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5
Q

neuro plasticity

A

brain tissue surrounding damaged brain re learns how to perform certain action

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6
Q

stroke is a clinical diagnosis, true or false

A

true

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7
Q

3 hallmarks of stroke

A
  1. acute onset - when did it start?
  2. focal neurological deficit
  3. disrupted blood flow / vascular cause: ischaemia vs haemorrhage
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8
Q

D.Dx of stroke ie stroke mimics

A 
Bells palsy 
Migraine 
Todd's paresis (post-ictal) 
Hypoglycaemia 
acute on chronic: brain tumour, MS, bleeding
Functional - non consistent symptoms
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9
Q

how to differentiate between types of stroke

A

non-contrast CT head

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10
Q

which is more common, ischaemic or haemorrhagic stroke

A

ischaemic

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11
Q

risk of having a second event is extremely high immediately after the first event, true or false

A

true

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12
Q

intracranial haemorrhages are not all stroke, true or false

A

true

can get extra/subdural/subarachnoid haemorrhages which is not the same as a stroke

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13
Q

describe the bleeding in a haemorrhagic stroke

A

intracerebral haemorrhage causing compression

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14
Q

neurosurgery will reverse haemorrhagic stroke, true or false

A

false
not usually involved unless life threatening
it will still not reverse the disability

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15
Q

haemorrhagic stroke is the same as intracerebral haemorrhage

A

yes

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16
Q

causes of haemorrhagic stroke

A 
anticoagulants perpetuate blood loss 
hypertension 
arteriosclerosis 
amyloid angiopathy 
vasculitis - any layer of vessel wall 
AVM 
aneurysms (more likely to be SAH)
extravascular causes:
- bleeding into tumour
- abscess
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17
Q

arteriosclerosis vs atherosclerosis

A

arteriosclerosis - not intimal disease, disease of tunica media muscle layer, calcification leads to hardening of artery like a tendon, can snap and bleed
not necessarily a HTN disease, more ageing
atherosclerosis - intimal disease with plaque deposition and cholesterol

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18
Q

types of intracerebral haemorrhages

A

peripheral /lobar haemorrhage

deep haemorrhage - more likely to be secondary to HTN

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19
Q

which carotid artery is concerned with the brain

A

ICA

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20
Q

where do the vertebral arteries arise from

A

subclavian arteries

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21
Q

where is the circle of willis found

A

CSF / subarachnoid

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22
Q

importance of circle of willis

A

collateral circulation to brain

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23
Q

large vessel occlusion almost always ischaemic

A

embolic
do it again
looks for source of embolus
ECG, scan…

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24
Q

what is affected in lacunar stroke

A

small infarcts from perforating arteries

thrombus

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25
Q

TIA

A

autothrombolyse

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26
Q

large vessel occlusion

A

cortical involvement

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27
Q

small vessel infsarcts

A

deep

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28
Q

how to differentiate between large and small vessel infarct

A

cortical involvement

large - cortical involvement

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29
Q

cortical signs

A

functions served by cerebral cortex

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30
Q

dominance

A

right vs left

deals with communication

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31
Q

examples of cortical dysfunction

A

dysphasia

32
Q

dysarthria

A

slurring of speech

not a neurological in origin, it is physical

33
Q

dysphasia

A

due to brain damage

difficulty in communication

34
Q

loses ability to understand

A

receptive dysphasia
‘fluent’
can talk back to you fluently but not the correct content

35
Q

loses ability to express themselves

A

expressive dysphasia
can understand you and follow instructions
but grammatically incorrect
non fluent

36
Q

agnosia

A

failure to recognise an object despite having intact motor, sensory and visual sensation

37
Q

apraxia

A

knowing it is a pen but unable to use it

38
Q

right hemisphere sided cortical infarct

A

neglect - left side doesnt exist, only right side, sitting up straight feels like pushing
changes in personality
sensory inattention
inattention - failure to pick up

39
Q

subtle signs of RHS

A

3D
spatial disorientation
changes in personality

40
Q

TACS

A

embolic

41
Q

lacs

A

physically disabled but able to communicate

42
Q

PACS

A

EMBOLIC

43
Q

LACS

A

intact cortex

44
Q

POCS

A

vertebrobasilar system

45
Q

TOAST classification for ischaemic strokes and TIA

A
  1. cardioembolic - AF
  2. large vessel atheroembolic - atherosclerosis
  3. small vessel - thrombotic disease
  4. infarcts due to other determined causes: dissection, hypoperfusion, vasospasm, paradoxical embolism, venous infarct
  5. cryptogenic - unknown cause
46
Q

Watershed stroke

A

border

47
Q

what is a venous infarct

A

gradual onset, diffuse symptoms with inclear origins
essentially a DVT in the veins of the brain
more likely to be haemorrhagic
need anticoagulation
venous sinus clogging

48
Q

paradoxical embolism as a cause of stroke is treated with thrombolysis, true or false

A

true

49
Q

TIA is a stroke mimic?

A

NO

TIA is a stroke

50
Q

difference between TIA and stroke

A

TIA - no disability

stroke - disability

51
Q

what is a TIA

A

transient neurological symptoms without brain damage

52
Q

TIAs need urgent investigation and management?

A

yes!

53
Q

commonest cause of AF

A

HTN

54
Q

Investigations for stroke

A 
bloods - FBC, U+E, LFT, lipids, glucose, clotting 
ECG
carotid doppler 
ambulatory monitoring 
ECHO
55
Q

> ? stenosis of carotid arteries qualify for carotid endarterectomy

A

> 70%

56
Q

when would you do a carotid endarterectomy for a patient with stroke/TIA

A

within 2 weeks of event

otherwise no benefit

57
Q

drugs for secondary prevention of stroke

A 
antiplatelets 
anticoagulants 
statins 
anti hypertensives 
DM 
lifestyle 
MDT
58
Q

What type of strokes would you use antiplatelets as secondary prevention for

A

ischaemic stroke

  • large vessel atheroembolic
  • small vessel
59
Q

types of antiplatelets used for stroke prevention

A

aspirin
clopidogrel
dipyridamole

60
Q

antiplatelet therapy post stroke

A

2 weeks of 300mg aspirin

then 75mg clopidogrel lifelong

61
Q

3 causes of stroke you would give anticoagulants to

A

cardioembolic
paradoxical embolic infarct
venous infarcts

62
Q

types of anticoagulants

A

warfarin

DOACs - dabigatran, apixiban, rivaroxiban, edoxiban

63
Q

INR of __ can still be thrombolysed

A

INR <1.5 can receive thrombolysis

64
Q

a patient on a DOAC automatically are excluded from thrombolysis, true or false

A

true

65
Q

what test can monitor warfarin

A

INR

66
Q

which one gives you predictable anticoagulation, warfarin or DOACs

A

DOACs

67
Q

warfarin/DOACs have variable dosing

A

warfarin has variable dosing

68
Q

warfarin/DOACs have fewer drug interactions

A

DOACs have fewer interactions

69
Q

prothrombin complex is used to reverse which anticoagulation?

A

warfarin

70
Q

delay start of anticoagulation depending on size of infarct, true or false

A

true
if there is no/small infarct, you can start it straight away
if it is larger, then there is a greater risk of haemorrhagic conversion

71
Q

which antihypertensives are thought to be effective in HTN for stroke

A

ACEI/ARBs

thiazide diuretics

72
Q

CT is better/worse at picking up acute stroke whereas MRI is better/worse at picking up acute stroke

A

CT better for acute stroke

MRI better for old stroke haemorrhage

73
Q

when the brain tissue is ischaemic, you lose the grey white interface, true or false

A

true

74
Q

when you have large infarcts, it may be normal to have haemorrhagic transformation

A

yes

75
Q

what is the main thing to rule out on imaging for stroke

A

haemorrhage

76
Q

dense vessel

A

thrombus in blood vessel

77
Q

deep infarct with sparing of the cortex

A

lacunar stroke

Year 4 General Medicine (16 decks)

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